Over one third of Americans suffer hypertension: the silent killer. We took a look at masked hypertension (when someone experiences higher ambulatory blood pressure readings than those in the doctor’s office) in our last post, and up next, we’d like to check out its opposite phenomena: white coat hypertension.

White Coat Syndrome

White coat syndrome (or effect) refers to a fairly common type of nervousness or anxiety people experience when visiting doctors. The term ‘white coat’ derives from the fact that medical doctors traditionally wore white jackets. This type of anxiety can spur from a distrust of doctors based on bad past experiences, a worry of receiving the wrong treatment, or perhaps from a fear of hearing bad news from a doctor. It is common to feel stressed about visiting the doctor, especially if you are waiting for results or undergoing an examination. It is estimated that nearly 20% of Americans suffer from some degree of white coat syndrome.

What is White Coat Hypertension?

White coat hypertension is an offshoot of white coat syndrome. It occurs when a person is anxious to have their blood pressure taken or be examined by a physician, so their blood pressure numbers present much higher in the doctor’s office than if measured at home. Generally, a person’s blood pressure should only vary by a few millimeters of mercury (mmHg) when taken at the doctor’s office versus at another location. This means no more of a variance than 10mmHg for the top number (systolic) and 5mmHg for the bottom number (diastolic). People with white coat hypertension may have a large fluctuation in their readings at a doctor’s office and relatively normal blood pressure when measured throughout the day at home.

Could White Coat Hypertension Lead to A Misdiagnosis?

While it is possible that a doctor may misdiagnose a person experiencing white coat hypertension as having actual hypertension, this would likely be a rare occurrence as most physicians would double check with ambulatory readings (using a portable blood pressure monitor at home). If a doctor suspects high blood pressure due to several in-office readings, they often suggest home monitoring for a 24-hour period or longer to cross check with their own readings to ensure the diagnosis is accurate before proceeding with treatment. If your doctor does not suggest home monitoring before trying to prescribe blood pressure treatment, you should certainly request it.

What Can be Done To Prevent White Coat Hypertension?

If you know you are experiencing this phenomenon, it is important to try to de-stress before entering a doctor’s office. You should also let your doctor know that your home readings have been in the normal range so that no unnecessary treatment ensues. If you are having trouble bringing your anxiety level down before visiting a doctor, take a look at some of our stress busters. People with more severe white coat syndrome may need to seek psychological therapy to figure out the root of their fear of medical environments and work toward dealing with it.

Can White Coat Hypertension Turn into Hypertension?

Yes. While it is common for everyone’s blood pressure to fluctuate during the run of a day, it is possible that someone who experiences significant stress-related blood pressure spikes may go on to develop high blood pressure. For this reason, you will likely continue to be monitored by your doctor (and at home) to ensure your blood pressure is in check in the future as well.

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